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Psychological Readiness and Kinesiophobia Are Not Associated With Effusion-Synovitis in Early Recovery After Anterior Cruciate Ligament Reconstruction.

Persyn FN, Blake NL, Grozier CD, Shingles M, Wilcox L, Schorfhaar A et al. ยท Journal of sport rehabilitation ยท 2026

Researchers used ultrasound to measure knee swelling (effusion-synovitis) in 52 people 4 to 6 months after ACL reconstruction, then compared their scores on questionnaires about fear of movement and psychological readiness to return to sport. People with moderate or severe swelling scored no differently than those with little or no swelling on either psychological measure.
Takeaway: Address post-ACLR fear of movement and return-to-sport confidence directly, rather than assuming they track with visible knee swelling.
Abstract (source)

Context Effusion-synovitis commonly develops following anterior cruciate ligament reconstruction (ACLR) and may influence physical and psychological recovery. We examined the association between effusion-synovitis severity and psychological readiness to return to sport and kinesiophobia at 4 to 6 months post-ACLR.

Design: Cross-sectional.

Methods: We assessed 52 participants (age = 18.4 [4.0] y; 27 females; time since surgery = 5.0 [0.9] mo) between 4 and 6 months post-ACLR. We graded effusion-synovitis using the Outcome Measures in Rheumatology ordinal scale (0 = absent to 3 = severe) from suprapatellar ultrasound images and dichotomized into absent/mild (grades 0-1, n = 24) and moderate/severe (grades 2-3, n = 28) groups. We assessed psychological readiness and kinesiophobia using the ACL Return to Sport after Injury Scale and the Tampa Scale of Kinesiophobia-11, respectively. We compared outcomes between groups using analysis of covariance models adjusted for time since surgery and sex. Sensitivity analyses treated effusion-synovitis as an ordinal variable (Spearman correlations) and as a binary variable (no effusion vs any effusion).

Results: Effusion-synovitis grade distribution: grade 0, n = 6 (11.5%); grade 1, n = 18 (34.6%); grade 2, n = 18 (34.6%); and grade 3, n = 10 (19.2%). We observed no significant between-group in kinesiophobia (absent/mild: 21.3 [5.4], moderate/severe: 22.0 [5.7]; F1,48 = 0.01, P = .927; 95% CI, 0.000-0.041) or psychological readiness (absent/mild: 62.2 [20.2], moderate/severe: 56.0 [27.2]; F1,48 = 0.00, P = .990; 95% CI, 0.000-0.000). Sensitivity analyses yielded consistent null

Findings: .

Conclusions: Effusion-synovitis severity did not associate with kinesiophobia or psychological readiness at 4 to 6 months post-ACLR, with small effect sizes.

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